The NAMDC Fellowship Program offers a unique training opportunity to senior postdoctoral clinical fellows who we anticipate will move on to the attending/assistant professor level in an academic setting as well-trained clinician scientists. The focus remains on translational medicine, teaching of diagnostic expertise and the development of clinical trials expertise. We aim to train the first of a new generation of clinician scientists who will be well equipped to move the promising new treatments for mitochondrial disease into the clinical arena. We plan to expand the program from seven training sites to nine. Our current sites include; Columbia, San Diego, Seattle, Cleveland, Hamilton, CHOP, and University of Florida. In this proposal we wish to add Baylor and University of Colorado at Denver. All are leading institutions in the new field of mitochondrial medicine. Each site brings a novel set of training experiences. World renowned faculty are to be found at each site. The initial exposure to mitochondrial patients, diagnosis and treatment will be provided during 3 to 6 months at UCSD in the Mitochondrial and Metabolic Disease Center. In this period an intensive clinical trials training program is required through the CREST program. Fellows will then choose to visit two or more consortium sites for periods from 1 to 3 months where a rich and varied training experience will be provided. The program will continue to be held together by regular telemedicine WebEx conferences involving all consortium sites. Data sharing is underway at all sites through the NAMDC database which the fellows will be actively involved with both at the patient entry level and analytically. At the end of their training the fellows will be encouraged to write a K award application.